This document provides information about osteoarthritis of the knee. It begins with an overview of osteoarthritis, noting that it affects 44-70% of people over age 55 and is more common in weight-bearing joints. Risk factors include age, obesity, injury, heredity, and other joint conditions. Symptoms include pain, stiffness, reduced mobility, and deformities like bowing of the legs. The pathophysiology involves wear and tear of cartilage over time. Treatment focuses on lifestyle modifications, exercises, braces, medications, injections, and surgery for advanced cases including joint replacement.

1. OSTEOARTHRITIS
Dr Jitendra sarangi
MS,DNB(Ortho)
MNAMS, FIOA
ASST. PROF,DEPT OF ORTHOPEDICS
SJMCH, PURI

2.  l Knee Pain Ruth Ann is a 62 yr old retired elementary school teacher She was touring through
Europe 3 weeks ago when she tripped on some cobblestone roads and landed straight on her
knee caps. She noticed some initial mild swelling the next day but had significant swelling and
pain after flying home. She is gradually improving but still complains of anterior and medial
pain bilaterally especially with descending stairs, prolonged standing greater than 15 minutes
and withKnee Symptoms indicating Structural Instability Swelling Locking Giving Way
Clicking Sudden, large effusion versus small delayed swelling Knee is stuck in position,
indicative of meniscal tear Knee buckles, unexpected fall, instability from ligament tear, large
meniscal tear Common and often non- painful, often patellar related
 14 14 Functional Assessment Screening Question
 15 15
 16 16
 17 17
 18 18
 19 19 Physical Exam What physical examination techniques would you use? We found:
Right Knee active flexion 110 degrees - pain end range, Passive flexion is 125 degrees - pain
end range. Left Knee active and passive flexion is full. Patellar compression causes pain on
right knee Mild Joint effusion on right knee Ligaments and mensici are intact Gait
demonstrates mild limp on right for first 5 steps then normalizes.
 using the elliptical machine at the gym

3. Osteoarthritis
or
O = Old age - A = Arthritis
As youAge

4. • The name osteoarthritis comes from
three Greek words meaning bone,
joint, and inflammation.

5. • Affected 44% - 70% of
population of age
55years
• Weight bearing joints
are more affected.
• There is no known cure
of the disease.
Progress can be controlled or delayed

7. BONES:
Femur, Tibia, Patella
CARTILAGE:
• Lining of the joint
• Shock absorber
MENISCUS:
Cushion in the joint
SYNOVIAL FLUID:
Lubricates the joint

8. 6
• As the opposing
cartilage surfaces
away, the
wear
knee collapses
causing
deformities such as
–
Bowleggedness
(Genu Varus)
Knock Knees
(Genu Valgus)

9. More
common in
women.
Obese people
(more body
weight).
When the
muscles of
the knee joint
are weak.

10.  Age
 Obesity
 Physical Inactivity
 Injury or Overuse (Athletes, Patients having Surgery, Fracture, or Soft
tissue injury surrounding the joint)
 Genetics or Heredity
 Muscle Weakness
 Other Types of Arthritis (RA, Septic Arthritis)
 Other Diseases or Conditions (Hemochromotosis, Acromegaly)

11. • Pain
• Stiffness
• Muscle spasm
• Restricted movement
• Deformity
• Muscle weakness or wasting
• Joint enlargement and instability
• Crepitus
• Joint Effusion

12. Complaints
Complaints
Get
stuck
at
times
Can’t go
up the
steps
Can’t
walk for a
small
distance
Joint
giving
way- Fear
of falling
Bow legs
Knock
knees
Can’t
sleep at
night
Joint
pain &
Stiffness

13. PAIN
Reduced Mobility and
Activity and thus
WEIGHT GAIN
Increased Joint
Stress
Cartilage
Deterioration
Synovitis

14. Wearing of
cartilage
lining
Exposure of
underlying
bone
Swelling of
joint lining
Bone at edges of joint
grows outwards
forming osteophytes
Arthritic
knee

15. Diagnosis
Clinical
X-rays

16. Life style
modifications
Physiotherapy
Nsaids
Braces
Supports

17. • Sitting on ground
• Squatting
• Sit-ups
• Climbing
• Commode
• High heels
• Shoe modification (lateral
wedges)
• Cane/walker
• Braces

18. Exercises – 4 Ds
• Golden rules:
– Do it
– Do it regularly
– Do it correctly
– Do not over do it
Free cycling for 5 – 10
minutes at zero
resistance. Can be
repeated twice a day

19. Quadriceps Sets
Tighten your thigh muscle and straighten your
knee. Then Hold for 5 to 10 seconds.
Repeat 10 times, rest a minute and again repeat.
Repeat several times till the thigh muscles get
fatigued.

20. Straight Leg Raises
Tighten the thigh muscles with knee fully
straightened. Lift leg at an angle of 45
degrees and hold for 5 to 10 seconds and
then slowly lower.

21. Ankle Pumps
Rhythmically move foot up and down by
contracting calf muscles. Repeat this exercise
for two to three minutes, thrice an hour a
day
. Continue doing the exercise until
swelling subsides.

22. Sitting Unsupported Knee Bends
Exercise Position – Sitting at bed side or in a chair
with feet resting on floor.
Slowly straighten your knee and hold the position for
5 – 10 seconds. Then lower the knee and repeat the
exercise several times.

23. • Brisk Walking
• Walking with Aids

24. Swimming

25. Braces
• Instability / lack of
confidence,
• Insecurity /
apprehension
• Meniscus tear
• Ligamentous laxity
• Unicompartmental
disease

26. 24
Hot or Cold Packs
TENS
Massage

27. 25
Loss can reduce
Weight
stress on weight-bearing
joints, limit further injury,
and increase mobility.
A Healthy Diet
and
Regular Exercise

28.  Ease the symptoms of the disease.
• Simple analgesics:
paracetamol, low dose
ibuprofen
• NSAID’s/Coxibs PRN regular
• Topical treatment eg NSAID
creams, capsaicin
• ‘Chondroprotective agents’

29. Injections (Hydrocortisone – Hyaluronic acid)
Arthroscopy (debridement)
Alignment corrective surgery (HTO)
Total / partial joint replacement

30. Hyaluronic acid injection
It is a viscosupplementation injection
that lubricates and cushions your joint.
Can provide
pain relief
upto 9
months
Efficacy: Low.
Price: High.
3 injections cost
Rs.15000

31. Arthroscopic debridement
• Joint debridement
• Removal of
mechanical
obstructions,
• Joint lavage
• Drilling of sclerotic
lesions

32. HTO for Varus Malalignment

33. High Tibial Osteotomy

34. Unicompartment
al knee
replacement
• Indications
• Unicompartmental arthritis
• Low-demand patients who
are older than 60
• Weight less than 82 kg
• Minimum 90° flexion arc
• Minimal deformity
• Intact anterior cruciate
ligament (ACL)

35. Replacing the damaged cartilage in the knee joint
with metal (Cobalt chrome) and highly specialised
plastic. These components are stuck to the bone with
cement
METAL
Cobalt-chrome
Stainless steel
PLASTIC
Specialized
polyethylene
CEMENT What’s new?
Oxynium knee
Fixed

36. • For advanced tricompartmental arthritis

41. Those who think they have no
time for bodily exercise will
sooner or later have to find
time for illness” —EdwardStanley,
British Prime Minister (1799-1869)